Hospitals lie at the heart of our ability to manage the significant potential health impacts of extreme weather events. Many people would be surprised to hear that the vast majority of our hospitals have not been designed with these risks in mind. And they have not been adapted to ensure they can maintain healthcare services during such events.

The recent thunderstorm asthma outbreak in Melbourne, which was linked to eight deaths and put 8,500 people in hospital, is a vivid example of the health impacts of extreme weather. Such events can be life-threatening, especially for the aged, obese and critically ill.

Individually, health services workers do a remarkable job in coping with such events. However, the buildings they work in and the infrastructure that supports them often constrain their ability to respond.

There are many reports of hospital buildings and infrastructure failing during extreme weather events in Australia. For example, power outages have affected numerous hospitals and back-up systems reportedly failed during the 2004 heatwaves that swept Australia.

During the 2005 Sydney heatwaves, hospitals were swamped. Many people were simply seeking respite in air-conditioned reception areas.

In 2006, Cyclone Larry closed much of Innisfail Hospital. Staff required medical support from Townsville and Cairns hospitals. Herberton Hospital was without power until a generator was provided. Leaking roofs resulted in emergency evacuations.

In 2009, one-in-100-year storms left more than 3,000 NSW residents stranded by floods, many of them old and seriously at risk. Floodwaters isolated Coffs Harbour, Dorrigo and Bellingen hospitals. People needing urgent medical treatment had to be sent up to 80 kilometres away.

Most recently, after super-cell thunderstorms blacked out South Australia, back-up generators failed at an Adelaide hospital. Seventeen patients had to be transferred from Flinders Medical Centre to Flinders Private Hospital.

What are the systemic problems?

These stories are worrying, but perhaps not surprising, given that most of our hospitals were designed when these risks were not on the horizon. In the quest for cheap land not suited to commercial development, many hospitals have been built in areas prone to floods and storms. And many are built out of materials and designed in a way that could increase the risk to patients during extreme weather events.

Hospitals face many challenges in adapting to a changing climate. Our research identified a long list of issues, including:

underfunded building and infrastructure maintenance and capital works programs

poor road access for new patients and back-up medical supplies

generators built in basements prone to flooding

lack of accommodation for staff trapped on site

poor coordination with other emergency and health agencies such as aged care

access roads being cut off

managers who do not understand the role of buildings in healthcare delivery

The impacts of extreme weather on hospital buildings and infrastructure and how these influence service delivery during such events have been neglected. These aspects of disaster planning systems need to be properly considered.

In the high-pressured, resource-stretched, highly politicised and hierarchical health sector, current disaster management practices too often overlook the role of buildings and infrastructure.

While severely limited resources are understandably directed towards frontline health service needs, the current system is creating a stock of health buildings and infrastructure that represent a risk, rather than an asset, to quality healthcare delivery during extreme weather events.

The designers and facilities managers of new hospitals are now required to think about these risks, but our understanding of how to mitigate the risks is poor. This means most of our hospitals and other health facilities remain vulnerable to the inevitable extreme weather events in the future.

It’s a matter of time before we see the next headline about needless death and suffering due to a hospital being poorly designed to cope with an extreme weather event.

How do we fix these problems?

The problems would be easier to overcome if we had a more holistic approach to disaster management planning. Such planning needs to better integrate the organisational and built environment aspects of hospital resilience.

This will require a paradigm shift in hospital disaster management. That, in turn, requires an emphasis on involving all hospital stakeholders in disaster management planning.

Hospital infrastructure design, planning, construction and ongoing maintenance need to be revisited. Robust quality control will be required to ensure compliance with improved standards consistent with changing needs.

We will inevitably need to redirect and find additional resources for building adaptation and modification. However, this is probably why nothing will change until we have a disaster big enough to force policymakers to change. Such is life … and death.

Martin Loosemore receives funding from the Australian Research Grants Council, including for research cited in this article.

Anumitra Mirti Chand does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

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